1. From the results, What would you recommend to Tak Hospital to improve the syphilis surveillance system?
A recurrent theme in the paper is the difficulty to operate the system when it comes to non-Thais. This is important as the majority of the Syphilis cases is attributable to non-Thais, and cases are likely to be underreported when it comes to migrants. As Thailand is becoming an increasingly attractive country to work and seek affordable medical treatment, this situation is only going to get worse. There needs to be more robust efforts in immigration control to ensure that all incoming migrants provide clean test results before being allowed to enter the country. Currently, the measures in place are not stringent enough, allowing many immigrants to enter by simply showing proof that they have performed an examination without requiring them to wait for the actual test results. This is alarming as they may be hidden Syphilis patients which could spread the disease in the community. There also needs to be better protocols in handling the medical affairs related to non-Thais. Currently, many workers don’t know how to handle non-Thais with the current system due to the lack of established protocols. Non-thais should be given a unique identification number, in the manner similar to Thai ID, when they enter the country or seek medical care for the first time. This would enable the migrants to have their own EMR in Thailand and allow hospitals and authorities across the country to track their records for different purposes.
2. Do you have experience with disease surveillance systems? What are the strengths and weaknesses of that system?
In Hong Kong, we only have disease surveillance systems for a selected list of communicable diseases. When doctors diagnose cases of one of these diseases, they will report to the centre of health protection which will keep monitoring the situation and keeping track of cases. This limited surveillance system for selected diseases need little resources to sustain, which makes it cost effective and protects most patients’ privacy since only patients with diseases that apply to the list need to have their data accessed. Even though it is inadequate, it has successfully limited and controlled outbreaks in the past, such as HFMD in schools. However, the lack of surveillance system for many other diseases have become a difficulty and nuisance in research. It is imaginable that if the government sets up a surveillance system compiling data from all hospitals covering more diseases including non-communicable ones such as cancer, it may reveal surprising insights and important health policy implications.